Hearing results in modified radical mastoidectomy with type III tympanoplasty

Yash D. Lavana, Ajay J. Panchal, Vaibhav B. Hapalia, Manit M. Mandal, Shivani D. Shah


Background: The objective of the study was to hear the results in patients with atticoantral-chronic otitis media who undergone canal wall down mastoidectomy with different types of tympanoplasty.

Methods: 86 cases of CSOM-AA were included. Patients were divided in 3 groups according to intra-operative ossicular chain status and reconstruction. Group A were patients having intact stapes superstructure and the graft kept over the stapes head covering middle ear and mastoid cavity. Group B patients were with intact superstructure of stapes and graft kept over cartilage graft kept on mobile stapes head. Group C patients were with absent superstructure of stapes with intact, mobile footplate and graft kept over autologous or homologous cartilage kept on footplate of stapes. On 10th week and 24th week after surgery, PTA was carried out to compare pre and post-operative hearing status. The study was conducted at SMIMER Hospital, Surat (a tertiary health care hospital) fromSeptember 2016 to September 2017.  

Results: In 86 patients, average mean preoperative AC threshold was 48.16 (±15.15) dB, mean pre-operative BC was 8.96 (±7.85) dB and mean pre-operative air bone gap was 40.11 (±12.92) dB. The mean post-operative AC threshold was 43.17 (±13.72) dB, mean post-operative BC was 11.34 (±9.44) dB and postoperative air bone gap was 32.06 (±11.62) dB. The mean air bone gap closure was 8.76 (±11.86). This hearing gain was statistically highly significant (p<0.001). Among 86 patients, cartilage was used in total 60 patients. Mean ABG was 8.6 dB, 11.05 dB and 8.43 dB respectively for tragal, conchal and homologous septal cartilage.  

Conclusions: Hearing improvement can be achieved with appropriate reconstruction in CWD mastoidectomy.


Canal wall down mastoidectomy, Tympanoplasty, Atticoantral chronic otitis media

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De Corso E, Marchese MR, Sergi B, Rigante M, Paludetti G. Role of ossiculoplasty in canal wall down tympanoplasty for middle- ear cholesteatoma: hearing results. J Laryngol Otol. 2007;121:324-8.

Uyar M. Hearing outcomes after suppurative chronic otitis media surgery. Turk J Ear Nose Throat. 2015;25(3):131-6.

Merchant SN, Ravicz ME, Voss SE, Peake WT, Rosowski JJ. Middle ear mechanics in normal, diseased and reconstructed ears. J Laryngol Otol. 1998;112:715-31.

Merchant SN, Rosowski JJ. Auditory Physiology and Middle-Ear Mechanics. In: Glasscock ME, Gulya AJ, eds. Surgery of the Ear. 5th ed. Ontario: BC Decker; 2003: 59-82.

Mudhol R, Naragund A, Shruthi V. Ossiculoplasty: revisited. Indian J Otolaryngol Head Neck Surg. 2012;65(S3):451-4.

Pinar E, Sadullahoglu K, Calli C, Oncel S. Evaluation of prognostic factors and middle ear risk index in tympanoplasty. Otolaryngol Head Neck Surg. 2008;139:386-90.

Kerr AG, Byrne JE, Smyth GD. Cartilage homograft in the middle ear: a long term histologic study. J Laryngol Otol. 1973;87:1193-9.

Iwanaga M, Mori H, Yamamoto E, Toda Y, Fukumoto M. The fate of homologous nasal septal cartilages in tympanoplasty. Acta Otolaryngol. 1986;101(3-4):306-13.

Felek SA, Islam A, Celik H, Demirci M, Samim E, Kose SK. The functional and anatomical results of the canal wall down tympanoplasty in extensive cholesteatoma. Acta Otolaryngol. 2009;129:1388-94.

Cook J, Krishnan S, Fagan P. Hearing results following modified radical versus canal-up mastoidectomy. Ann Otol Rhinol Laryngol. 1996;105:379-83.

Shelton C, Sheehy JL. Tympanoplasty: review of 400 staged cases. Laryngoscope. 1990;100:679-81.

Berenholz LP, Rizer FM, Burkey JM, Schuring AG, Lippy WH. Ossiculoplasty in canal wall down mastoidectomy. Otolaryngol Head Neck Surg. 2000;123:30-3.

Babighian G. Posterior and attic wall osteoplasty: hearing results and recurrence rates in cholesteatoma. Otol Neurotol. 2002;23:14-7.

Artuso A, Di Nardow, De Corso E, Marchese MR, Quaranta N. Canal Wall Down tympanoplasty surgery with or without ossiculoplasty in cholesteatoma: hearing results. Acta Otorhinolaryngol Ital. 2004;24:2-7.

Shrestha BL, Bhusal CL, Bhattarai H. Comparison of pre and post-operative hearing results in canal wall down mastoidectomy with type III tympanoplasty. JNMA J Nepal Med Assoc. 2008;47:224-7.